Devices and methods for breaking and retaining surgical reduction tabs

ABSTRACT

Various devices and methods for breaking and retaining surgical reduction tabs are provided. In general, the devices and methods can allow a single surgical instrument to break a plurality of surgical reduction tabs off one or more surgical implants and retain the broken tabs within the instrument. In an exemplary embodiment, a surgical instrument can include an opening at a distal end thereof that is configured to receive a surgical reduction tab therein when the tab is connected to a surgical implant. A retention element at least partially disposed within the instrument can be configured to engage the tab received in the opening so as to hold the tab securely within the instrument. With the tab received in the opening and held by the retention element, the surgical instrument can be configured to be manipulated to break the tab off the surgical implant. The broken tab can be retained within the surgical instrument by being held therein by the retention element. The instrument can be repeatedly relocated and repeatedly break off surgical reduction tabs of one or more surgical implants, with each successive tab received in the opening displacing the immediately preceding broken tab from the retention element such that a chamber formed in the instrument can simultaneously hold a plurality of broken tabs within the instrument.

CROSS REFERENCE TO RELATED APPLICATIONS

The present application is a continuation of U.S. application Ser. No.15/193,857 filed on Jun. 27, 2016, which is a continuation of U.S.application Ser. No. 14/021,203 filed on Sep. 9, 2013, which claimspriority to U.S. Provisional Application No. 61/706,860 entitled“Devices And Methods For Breaking And Retaining Surgical Reduction Tabs”filed on Sep. 28, 2012, each of which is hereby incorporated byreference in its entirety.

FIELD

The present disclosure relates generally to devices and methods forbreaking and retaining surgical reduction tabs.

BACKGROUND

Some types of conventional surgical implants can have one or morereduction tabs extending therefrom. Conventional spinal anchors, fornon-limiting example, typically have two opposed reduction tabsextending proximally therefrom. The reduction tabs of a surgical implantcan be used in implanting the surgical implant, and then the reductiontabs can be broken off the implanted surgical implant to reduce aclearance height of the surgical implant, which can help prevent thesurgical implant from damaging tissue and/or other material adjacent tothe implant.

However, conventional devices used to break reduction tabs can only beused to break a small number of reduction tabs, typically one or two,before the device must be reoriented so that an opposite end of thedevice can be used and/or be removed from a patient and cleared of thebroken tab(s) to break off another small number of reduction tabs,typically one or two. It can therefore take a significant amount of timeto break all reduction tabs that need to be broken in a surgicalprocedure, as tens of reductions tabs can be needed to be broken in asingle surgical procedure.

Some conventional devices used to break reduction tabs off of animplanted implant cannot retain the broken reduction tabs within thedevice, thereby leaving broken reduction tabs loose within the patientthat need to be removed from the patient prior to ending the surgicalprocedure. Conventional broken reduction tabs are relatively small,which can make them difficult to retrieve in a patient. Further, sincenumerous reduction tabs may be broken in a single surgical procedure, itcan take a significant amount of time to retrieve all of the loosebroken reduction tabs. While some conventional devices used to breakreduction tabs off of an implanted implant can retain the brokenreduction tabs within the device, only a small number of brokenreduction tabs, e.g., four or less or two or less, can be retainedwithin the device before the device has to be replaced during a surgicalprocedure with another device to break and retain more reduction tabsand/or the device has to be removed from the patient and unloaded ofbroken tabs before being used to break more reduction tabs. It cantherefore take a significant amount of time to break all reduction tabsthat need to be broken in a surgical procedure, as tens of reductionstabs can be needed to be broken in a single surgical procedure.

Accordingly, there remains a need for devices and methods for breakingand retaining surgical reduction tabs.

SUMMARY

The present invention generally provides devices and methods forbreaking and retaining surgical reduction tabs.

In one aspect, a surgical apparatus is provided that in one embodimentincludes an elongate shaft and a retention element disposed at leastpartially within the shaft. The shaft can have proximal and distal ends,an opening at the distal end of the shaft, and a chamber formed thereinproximal to and in communication with the opening. The distal end of theshaft can be configured to be advanced into a body of a patient, and theopening can be configured to receive a reduction tab of a surgicalimplant. The retention element can be located adjacent the opening andcan be configured to hold the retention tab received in the opening in afixed position relative to the shaft. The shaft can be configured to bemanipulated to break the retention tab received in the opening and heldby the retention element off from the surgical implant, and the chambercan be configured have the broken reduction tab disposed therein.

The plurality of broken reduction tabs can vary in number. For example,the plurality of broken reduction tabs can be at least five tabs. Forexample, the plurality of broken reduction tabs can be in a range offive to fifty tabs.

The chamber can be configured to have a plurality of broken reductiontabs simultaneously disposed therein.

The opening can be configured to sequentially receive the reduction taband a plurality of additional reduction tabs of one or more surgicalimplants. The retention element can be configured to sequentially holdthe reduction tab and each of the plurality of additional reduction tabsin a fixed position relative to the shaft. The shaft can be configuredto be manipulated to break each of the plurality of additional retentiontabs received in the opening and held by the retention element off ofthe one or more surgical implants. The chamber can be configured havethe reduction tab and each of the broken additional reduction tabssimultaneously disposed therein. A first one of the plurality ofreduction tabs can be configured to move the broken reduction tab fromthe fixed position and into the chamber. Each of a remainder of theplurality of reduction tabs can be configured to move an immediatelypreceding broken one of the reduction tabs from the fixed position andinto the chamber. A first one of the plurality of reduction tabs can beconfigured to move the broken reduction tab proximally within the shaft.Each of a remainder of the plurality of reduction tabs can be configuredto move an immediately preceding broken one of the reduction tabsproximally within the shaft. The plurality of broken reduction tabs canbe at least five tabs and/or can be a range of five to fifty tabs.

The retention element can have any number of variations. For example,the retention element can be spring loaded. For another example, theretention element can direct a force toward an interior sidewall of theshaft such that the retention tab received in the opening is heldbetween the retention element and the interior sidewall of the shaft.For yet another example, the retention element can have a pinch point ina distal portion thereof. The pinch point can be disposed adjacent toand proximal to the opening and can be configured to directly contactthe retention tab received in the opening so as to hold the retentiontab received in the opening in the fixed position. The pinch point canbe disposed between the opening and a distal-most end of the chamber.For another example, the retention element can be configured to movebetween a first configuration in which the retention element is in afirst position relative to a longitudinal axis of the shaft and a secondconfiguration in which the retention element is in a second positionrelative to the longitudinal axis of the shaft. The second position canbe radially offset from the first position relative to the longitudinalaxis. For still another example, the retention element can include a barat least partially disposed within the shaft.

The shaft can have a proximal opening in a proximal portion thereof. Theproximal opening can be in communication with the chamber such that anybroken retention tabs held in the chamber can be released from thechamber through the proximal opening.

The surgical apparatus can include a release element coupled to theretention element. The release element can be configured to be actuatedto cause any broken retention tabs of surgical implants held in thechamber to be released from the chamber through the opening.

The reduction tab of the surgical implant can include a reduction tabextending proximally from a head of a surgical screw having a shankextending distally from the head.

In another embodiment, a surgical apparatus is provided that includes anelongate shaft and a retention element. The shaft can have an opening ata distal end thereof and a chamber formed therein that is incommunication with the opening. The opening can be configured tosequentially receive a plurality of breakable extension tabs of one ormore surgical implants therein. The shaft can be configured to bemanipulated to sequentially break each of the breakable extension tabsoff the one or more surgical implants. The chamber can be configured toretain each of the breakable extension tabs therein after the breakableextension tabs have been broken off the one or more surgical implants bymanipulating the shaft. The retention element can be disposed at leastpartially within the shaft and located adjacent the opening. Theretention element can be configured to sequentially engage each of thebreakable extension tabs received in the opening within the shaft beforethe shaft is manipulated to sequentially break each of the breakableextension tabs off the one or more surgical implants. The retentionelement can be configured to hold within the shaft each of the breakableextension tabs after having been broken off the one or more surgicalimplants by manipulating the shaft.

Each of the broken breakable extension tabs except a last one of thebroken breakable extension tabs can be displaced from being held by theretention element by a subsequent one of the breakable extension tabsreceived in the opening so as to sequentially advance each of the brokenbreakable extension tabs except the last one of the broken breakableextension tabs into the chamber.

The chamber can be configured to have a plurality of breakable extensiontabs simultaneously disposed therein. The plurality of broken breakableextension tabs can be at least five tabs and/or can be in a range offive to fifty tabs.

The opening can be configured to sequentially receive the breakableextension tab and a plurality of additional breakable extension tabs ofone or more surgical implants. The retention element can be configuredto sequentially hold the breakable extension tab and each of theplurality of additional breakable extension tabs in a fixed positionrelative to the shaft. The shaft can be configured to be manipulated tobreak each of the plurality of additional breakable extension tabsreceived in the opening and held by the retention element off of the oneor more surgical implants. The chamber can be configured have thebreakable extension tab and each of the broken additional breakableextension tabs simultaneously disposed therein. A first one of theplurality of breakable extension tabs can be configured to move thebroken breakable extension tab from the fixed position and into thechamber, and each of a remainder of the plurality of breakable extensiontabs can be configured to move an immediately preceding broken one ofthe breakable extension tabs from the fixed position and into thechamber. A first one of the plurality of breakable extension tabs can beconfigured to move the broken breakable extension tab proximally withinthe shaft, and each of a remainder of the plurality of reduction tabsbeing configured to move an immediately preceding broken one of thebreakable extension tabs proximally within the shaft. The plurality ofbroken breakable extension tabs can be at least five tabs and/or can bein a range of five to fifty tabs.

The retention element can have any number of variations. For example,the retention element can be spring loaded. For another example, theretention element can direct a force toward an interior sidewall of theshaft such that the breakable extension tab received in the opening isheld between the retention element and the interior sidewall of theshaft. For yet another example, the retention element can have a pinchpoint in a distal portion thereof. The pinch point can be configured todirectly contact the breakable extension tab received in the opening soas to hold the breakable extension tab received in the opening in thefixed position. The pinch point can be disposed between the opening anda distal-most end of the chamber. For another example, the retentionelement can be configured to move between a first configuration in whichthe retention element is in a first position relative to a longitudinalaxis of the shaft and a second configuration in which the retentionelement is in a second position relative to the longitudinal axis of theshaft. The second position can be radially offset from the firstposition relative to the longitudinal axis. For still another example,the retention element can include a bar at least partially disposedwithin the shaft.

The shaft can have a proximal opening in a proximal portion thereof. Theproximal opening can be in communication with the chamber such that anybroken breakable extension tabs of surgical implants held in the chambercan be released from the chamber through the proximal opening.

The apparatus can include a release element coupled to the retentionelement. The release element can be configured to be actuated to causeany broken breakable extension tabs held in the chamber to be releasedfrom the chamber through the opening.

The apparatus of claim 20, wherein the breakable extension tab of thesurgical implant comprises a breakable extension tab extendingproximally from a head of a surgical screw having a shank extendingdistally from the head.

In another aspect, a surgical kit is provided that includes a surgicalapparatus, e.g., any of the surgical apparatuses described herein. Inone embodiment, the kit can include a plurality of surgical implantseach having at least one reduction tab configured to be disposed withinan opening of a shaft of the apparatus, broken by manipulating theshaft, and simultaneously retained in a chamber of the apparatus.

In another aspect, a surgical method is provided that includes disposinga first reduction tab of a first surgical implant implanted within apatient within an opening at a distal end of an elongate shaft such thata retention element disposed at least partially within the shaft engagesthe first reduction tab, manipulating the shaft to break the firstreduction tab disposed within the opening off of the first surgicalimplant, retaining the broken first reduction tab within the shaft bythe retention element holding the broken first reduction tab in a fixedposition relative to the shaft, disposing a second reduction tab of asecond surgical implant implanted within the patient within the openingsuch that the retention element engages the second reduction tab,manipulating the shaft to break the second reduction tab disposed withinthe opening off of the second surgical implant, and retaining the brokensecond reduction tab within the shaft such that the broken first andsecond reduction tabs are simultaneously retained within the shaft.

The method can vary in any number of ways. For example, disposing thesecond reduction tab within the opening can move the broken firstreduction tab from being held in the fixed position relative to theshaft to being disposed within a chamber formed in the shaft. Foranother example, disposing the second reduction tab within the openingcan move the broken first reduction tab proximally within the shaft. Foryet another example, disposing the second reduction tab within theopening can cause the broken first reduction tab to be loosely disposedwithin the chamber. For another example, the retention element canretain the broken first reduction tab within the shaft by applying aspring force thereto, and the retention element can retain the brokensecond reduction tab within the shaft by applying a spring forcethereto. For still another example, the method can include sequentiallydisposing a plurality of additional reduction tabs of at least oneadditional surgical implant implanted within the patient within theopening such that the retention element sequentially engages each of theplurality of additional reduction tabs, manipulating the shaft tosequentially break each of the plurality of additional reduction tabsdisposed within the opening off of the at least one additional surgicalimplant, and retaining each of the broken plurality of additionalreduction tabs within the shaft such that the broken first and secondreduction tabs and the broken plurality of additional reduction tabs aresimultaneously retained within the shaft.

BRIEF DESCRIPTION OF DRAWINGS

This invention will be more fully understood from the following detaileddescription taken in conjunction with the accompanying drawings, inwhich:

FIG. 1 is a perspective view of one embodiment of a surgical instrumentconfigured to break and retain surgical reduction tabs, the instrumenthaving a reduction tab attached to an implant inserted in an openingformed in a distal end of the instrument;

FIG. 2 is a cross-sectional view of the instrument of FIG. 1;

FIG. 3 is a distal end view of the instrument of FIG. 1;

FIG. 4 is a partial cross-sectional view of the instrument of FIG. 1;

FIG. 5 is a another partial cross-sectional view of the instrument ofFIG. 1;

FIG. 6 is a cross-sectional view of the instrument of FIG. 1 having thereduction tab disposed therein, the reduction tab having been broken offthe implant;

FIG. 7 is another cross-sectional view of the instrument of FIG. 1having the reduction tab disposed therein, the reduction tab having beenbroken off the implant;

FIG. 8 is a perspective view of another embodiment of a surgicalinstrument configured to break and retain surgical reduction tabs;

FIG. 9 is a cross-sectional view of the instrument of FIG. 8;

FIG. 10 is a partial cross-sectional view of the instrument of FIG. 8;

FIG. 11 is a perspective view of yet another embodiment of a surgicalinstrument configured to break and retain surgical reduction tabs;

FIG. 12 is a cross-sectional view of the instrument of FIG. 11;

FIG. 13 is a partial cross-sectional view of the instrument of FIG. 11;

FIG. 14 is a partial perspective view of the instrument of FIG. 11;

FIG. 15 is a perspective view of another embodiment of a surgicalinstrument configured to break and retain surgical reduction tabs;

FIG. 16 is a cross-sectional view of the instrument of FIG. 15;

FIG. 17 is another perspective view of the instrument of FIG. 15;

FIG. 18 is a partial cross-sectional view of the instrument of FIG. 15;

FIG. 19 is another partial cross-sectional view of the instrument ofFIG. 15;

FIG. 20 is a perspective view of still another embodiment of a surgicalinstrument configured to break and retain surgical reduction tabs;

FIG. 21 is a cross-sectional view of the instrument of FIG. 20;

FIG. 22 is a partial cross-sectional view of the instrument of FIG. 20;

FIG. 23 is another perspective view of the instrument of FIG. 20;

FIG. 24 is a perspective view of yet another embodiment of a surgicalinstrument configured to break and retain surgical reduction tabs;

FIG. 25 is a cross-sectional view of the instrument of FIG. 24;

FIG. 26 is a partial perspective view of the instrument of FIG. 24;

FIG. 27 is a partial cross-sectional view of the instrument of FIG. 24;

FIG. 28 is another partial cross-sectional view of the instrument ofFIG. 24;

FIG. 29 is another perspective view of the instrument of FIG. 24;

FIG. 30 is a perspective view of another embodiment of a surgicalinstrument configured to break and retain surgical reduction tabs;

FIG. 31 is a cross-sectional view of the instrument of FIG. 30;

FIG. 32 is a partial perspective view of the instrument of FIG. 30;

FIG. 33 is a partial cross-sectional view of the instrument of FIG. 30;

FIG. 34 is another partial cross-sectional view of the instrument ofFIG. 30;

FIG. 35 is a cross-sectional view of another embodiment of a surgicalinstrument configured to break and retain surgical reduction tabs;

FIG. 36 is a perspective view of yet another embodiment of a surgicalinstrument configured to break and retain surgical reduction tabs;

FIG. 37 is another perspective view of the instrument of FIG. 36;

FIG. 38 is a perspective view of another embodiment of a surgicalinstrument configured to break and retain surgical reduction tabs;

FIG. 39 is another perspective view of the instrument of FIG. 38;

FIG. 40 is yet another perspective view of the instrument of FIG. 38;

FIG. 41 is a perspective view of still another embodiment of a surgicalinstrument configured to break and retain surgical reduction tabs;

FIG. 42 is another perspective view of the instrument of FIG. 41;

FIG. 43 is a perspective view of another embodiment of a surgicalinstrument configured to break and retain surgical reduction tabs;

FIG. 44 is another perspective view of the instrument of FIG. 43;

FIG. 45 is still another perspective view of the instrument of FIG. 43;

FIG. 46 is a partial cross-sectional view of another embodiment of asurgical instrument configured to break and retain surgical reductiontabs;

FIG. 47 is a partial cross-sectional view of yet another embodiment of asurgical instrument configured to break and retain surgical reductiontabs;

FIG. 48 is a perspective view of another embodiment of a surgicalinstrument configured to break and retain surgical reduction tabs;

FIG. 49 is a distal end view of the instrument of FIG. 48;

FIG. 50 is a side view of the instrument of FIG. 48;

FIG. 51 is a cross-sectional view of the instrument of FIG. 50;

FIG. 52 is another side view of the instrument of FIG. 48;

FIG. 53 is a cross-sectional view of the instrument of FIG. 52;

FIG. 54 is an exploded view of the instrument of FIG. 48;

FIG. 55 is a perspective view of another embodiment of a surgicalinstrument configured to break and retain surgical reduction tabs;

FIG. 56 is a distal end view of the instrument of FIG. 55;

FIG. 57 is a side view of the instrument of FIG. 55;

FIG. 58 is a cross-sectional view of the instrument of FIG. 57;

FIG. 59 is another side view of the instrument of FIG. 55;

FIG. 60 is a cross-sectional view of the instrument of FIG. 59; and

FIG. 61 is an exploded view of the instrument of FIG. 55.

DETAILED DESCRIPTION

Certain exemplary embodiments will now be described to provide anoverall understanding of the principles of the structure, function,manufacture, and use of the devices and methods disclosed herein. One ormore examples of these embodiments are illustrated in the accompanyingdrawings. Those skilled in the art will understand that the devices andmethods specifically described herein and illustrated in theaccompanying drawings are non-limiting exemplary embodiments and thatthe scope of the present invention is defined solely by the claims. Thefeatures illustrated or described in connection with one exemplaryembodiment may be combined with the features of other embodiments. Suchmodifications and variations are intended to be included within thescope of the present invention.

Various devices and methods are provided for breaking and retainingsurgical reduction tabs. In general, the devices and methods can allow asingle surgical instrument to break a plurality of surgical reductiontabs off one or more surgical implants and retain the broken tabs withinthe instrument. Surgical reduction tabs are also referred to herein as“breakable extension tabs.”

In an exemplary embodiment, a surgical instrument can include an openingat a distal end thereof that is configured to receive a first surgicalreduction tab therein when the first tab is connected to a surgicalimplant. A retention element at least partially disposed within thesurgical instrument can be configured to engage the first tab receivedin the opening so as to hold the first tab securely within theinstrument. With the first tab received in the opening and held by theretention element, the surgical instrument can be configured to bemanipulated to break the first tab off the surgical implant, such as byrotating the surgical instrument and/or angling the surgical instrumentrelative to the surgical implant. The broken first tab can be retainedwithin the surgical instrument by being held therein by the retentionelement. The surgical instrument can then be relocated, and a secondsurgical reduction tab of either the same surgical implant or adifferent surgical implant can be advanced into the opening at theinstrument's distal end without the need to change the orientation ofthe surgical instrument. The second tab can displace the broken firsttab from the retention element such that the broken first tab movesproximally within the instrument into a chamber formed in the surgicalinstrument, and the retention element can securely hold the second tab.The surgical instrument can be configured to be manipulated to break thesecond tab off its associated surgical implant, with the retentionelement holding the broken second tab so as to retain the broken secondtab within the instrument already having the broken first tab retainedtherein. The instrument can be repeatedly relocated and repeatedly breakoff surgical reduction tabs of one or more surgical implants, with eachsuccessive tab received in the opening, e.g., on a same distal side ofthe instrument, displacing the immediately preceding broken tab from theretention element such that the chamber can simultaneously hold aplurality of broken tabs, e.g., up to fifty tabs, within the instrument.

The instrument can thus simultaneously retain a plurality of broken tabstherein, which can allow the instrument to break off multiple tabswithout the instrument having to be removed from a patient's body toallow removal of broken tabs from the instrument before using theinstrument to break off more tabs, which can save time since a singlesurgical procedure can include breaking off numerous tabs from one ormore surgical implants. Also, since the instrument can be configured toreceive each of the tabs in a same opening thereof, e.g., the distal endopening, the instrument need not be turned over or otherwiserepositioned within a surgeon's hand during tab breaking, which can savetime, since multiple tabs are typically successively broken near an endof a surgical procedure, and/or can be less cumbersome to use thaninstruments that must be turned over or repositioned within a surgeon'shand for the instrument to effectively break off multiple tabs.

The instrument can include a release mechanism configured to allowrelease of broken tabs retained therein from the instrument. Theinstrument can thus be configured to be reused with a same patientduring a single surgical procedure if the instrument retains, orapproaches retaining, a maximum number of broken tabs therein. Therelease mechanism can allow removal of the maximum number, or nearmaximum number, of broken tabs therefrom, thereby allowing theinstrument to continue being used to break and retain tabs in the singlesurgical procedure, which can save time and can reduce a number ofinstruments used in the surgical procedure, which can reduce operatingroom clutter and/or reduce monetary cost. The instrument can also beconfigured to be reused with different patients in different surgicalprocedures by removing broken tabs therefrom using the release mechanismand then processing the instrument for reuse by cleaning,decontaminating, sterilizing, etc. the instrument in any one or moreways, as will be appreciated by a person skilled in the art.

Various types of surgical implants can include surgical reduction tabs,such as a head of a spinal anchor, e.g., a spinal screw, configured toseat a spinal fixation element, e.g., a spinal rod, therein. In the caseof a spinal anchor, two surgical reduction tabs can extend proximallyfrom opposed sides of a head of the spinal fastening member, and aspinal fastening member, e.g., a shank, can extend distally from thehead. One embodiment of a spinal anchor including reduction tabs is theEXPEDIUM® Favored Angle Screw available from DePuy Synthes Spine, Inc.of Raynham, Mass. Various embodiments of spinal anchor assembliesincluding reduction tabs are further discussed in U.S. Pat. No.6,755,829 entitled “Lock Cap Anchor Assembly For Orthopaedic Fixation”issued Jun. 29, 2004, which is hereby incorporated by reference in itsentirety. However, as mentioned above, the surgical instrumentsdisclosed herein can be used with any type of surgical implant that hasone or more breakable extension tabs extending therefrom that areconfigured to be broken off the surgical implant, e.g., to be broken offafter the surgical implant has been implanted in a patient's body andthe tab(s) are no longer needed to facilitate implantation of theimplant.

The surgical instruments disclosed herein can be formed of one or morematerials. In an exemplary embodiment, the one or more materials arebiocompatible so as to be safe for use in surgery. In an exemplaryembodiment, the one or more materials can be rigid, e.g., stainlesssteel, titanium, etc., which can help the instrument break reductiontabs off surgical implants without the instrument itself breaking andwithout the instrument flexing so much while attempting to break areduction tab that the instrument cannot exert enough force on thereduction tab to cause the reduction tab to break.

FIGS. 1-7 illustrate an embodiment of a surgical instrument 100configured to break and retain multiple reduction tabs of one or moresurgical implants. As shown in FIGS. 1 and 2, the instrument 100 caninclude an elongate shaft 102 having a proximal end 102 p and a distalend 102 d. The shaft 102 can have an opening 104 formed at the distalend 102 d thereof. The opening 104 can be configured to receive a firstreduction tab 106 a of a surgical implant therein. The opening 104 canalso be configured to receive a second reduction 106 b of the surgicalimplant therein, as discussed further below. FIGS. 1, 2, and 4 show thefirst reduction tab 106 a received in the opening 104, while FIG. 3shows the opening 104 without the first reduction tab 106 a, the secondreduction tab 106 b, or any other reduction tab in the opening 104. Thefirst and second reduction tabs 106 a, 106 b in the illustratedembodiment extend upwardly from a head 108 of a spinal anchor assembly.For ease of illustration, the spinal anchor assembly is only partiallyillustrated in FIGS. 1 and 2, e.g., a threaded polyaxial shank extendingfrom the head 108 is not shown.

The shaft 102 can also include a retention element 110 at leastpartially disposed within the shaft 102. The retention element 110 canbe disposed adjacent the opening 104 and can be configured to hold thefirst reduction tab 106 a in a fixed position relative to the shaft 102when the first reduction tab 106 a is received in the opening 104. Inother words, when the first reduction tab 106 a is received in theopening 104, the retention element 110 can directly engage the reductiontab 106 a so as to retain the first reduction tab 106 a in place. Theretention element 110 can thus be configured to facilitate breakage ofthe first reduction tab 106 a from the surgical implant that includesthe head 108 by helping to hold the first reduction tab 106 a in a fixedposition relative to the shaft 102 when the first reduction tab 106 a isbeing broken via manual manipulation of the shaft 102. As shown in FIG.2, the shaft 102 can also include a chamber 112 formed thereinconfigured to hold broken reduction tabs therein at least after thefirst reduction tab 106 a has been broken off the head 108. Theretention element 110 can be configured to prevent broken reduction tabsfrom being released from the chamber 112 in cooperation with a releasemechanism 114 of the instrument 100, as discussed further below.

The shaft 102 can have a variety of sizes, shapes, and configurations.The shaft 102 can generally have an elongate shape, which can facilitateinsertion of at least a portion of the shaft 102 into a body of apatient. The shaft 102 in the illustrated embodiment has a cylindricalshape along a longitudinal length thereof in a proximal region of theshaft 102, although the proximal region of the shaft 102 can have ashape other than cylindrical. The cylindrical shape can facilitatesmooth insertion of the shaft 102 through into a patient's body, eitherdirectly or through an introducer device such as a cannula. A personskilled in the art will appreciate that the proximal region of the shaft102 may not be precisely cylindrical due to manufacturing tolerances butnevertheless be considered cylindrical. The proximal region of the shaft102 can have a width that is greater than a width of a distal region ofthe shaft 102, which can facilitate retention of a plurality of brokenretention tabs within the shaft 102 in the proximal region thereof,provide adequate space in the shaft 102 for the retention element 110and/or the release mechanism 114, and/or facilitate secure holding of areduction tab by the retention element 110 in the distal region of theshaft 102. The distal region of the shaft 102 can have a shape differentthan that of the proximal region, as in the illustrated embodiment inwhich the distal region has a rectangular box shape, or a same shape asthe proximal region. The distal portion can have a shape other than as arectangular box, but by having planar sides such as by havingrectangular box shape, the distal portion can facilitate advancement ofbroken reduction tabs proximally within the shaft 102.

At least a portion of the shaft 102 can be configured to be advancedinto a body of a patient. The portion of the shaft 102 configured to beso advanced can include at least the distal end 102 d of the shaft 102including the opening 104, thereby allowing the shaft 102 to facilitatebreaking the reduction tab 106 a off the implant after the implant hasbeen implanted into the patient's body, e.g., after the shank of theimplant has been threaded into bone.

The opening 104 at the distal end 102 d of the shaft 102 can have avariety of sizes, shapes, and configurations. In an exemplaryembodiment, the opening 104 can have a generally rectangular shape, asshown in FIG. 3, in which the opening 104 has a generally rectangularshape with rounded edges. By having a generally rectangular shape, theopening 104 can be configured to interchangeably receive reduction tabstherein having a concave side facing the retention element 110, such asthe first retention tab 106 a as shown in FIGS. 1, 2, 4, 6, and 7 and athird reduction tab 106 c disposed within the chamber 112 as shown inFIGS. 2-4, 6, and 7, or having a convex side facing the retentionelement 110, such as a fourth reduction tab 106 d and a fifth reductiontab 106 e as shown in FIGS. 2-4, 6, and 7. Because a same surgicalimplant can include a plurality of reduction tabs with one or more ofthe tabs having a different orientation than one or more of the othertabs when the tabs are attached to the implant, such as the illustratedimplant having reduction tabs 106 a, 106 b with facing concave surfaces,the opening 104 having a shape configured to interchangeably receive thedifferently oriented reduction tabs can allow the differently orientedreduction tabs to be received therein without having to rotate theopening 104 relative to the implant. The shaft 102 can thus besequentially receive reduction tabs within the opening 104 without theshaft 102 needing to be turned over or otherwise repositioned within asurgeon's hand when successively breaking multiple tabs off one or moresurgical implants, which can save time and/or make the instrument 100easier to use in a small surgical space.

In another embodiment (not shown), an opening at a distal end of anelongate shaft can have an arc shape mimicking an arced cross-sectionalshape of a reduction tab, such as the first, second, third, fourth, andfifth reduction tabs 106 a, 106 b, 106 c, 106 d, 106 e which have arcedcross-sections. The arced cross-sectional shape of the opening can helpensure that a particular side of a reduction tab inserted into theopening faces a retention element at least partially disposed within theshaft, which can facilitate secure holding of the tabs by the retentionelement, e.g., by having a convex surface of the tab protrude toward theretention element.

Referring again to the embodiment of FIGS. 1-7, the chamber 112 formedin the shaft 102 can have a variety of sizes, shapes, andconfigurations. The chamber 112 can have a width that is equal to orgreater than a width 104 w of the opening 104, shown in FIG. 3, and canhave a depth that is equal to or greater than a depth 104 d of theopening 104, also shown in FIG. 3, which can help ensure that reductiontabs inserted into the opening 104 can also fit into the chamber 112.The chamber 112 can thus have a width that is at least as large as awidth of and can have a depth that is at least as large as a depth ofreduction tabs configured to be received in the opening 104 and brokenby the shaft 102. In the illustrated embodiment, the chamber 112 has awidth equal to the width 104 w of the opening 104 and a depth equal tothe depth 104 d of the opening 104.

A chamber formed in a shaft of a surgical instrument can be configuredto allow broken reduction tabs to be loose therein or be non-looselyheld therein. In the illustrated embodiment, the chamber 112 isconfigured to hold broken reduction tabs non-loosely therein with thebroken reduction tabs being longitudinally aligned in a row, as shown inFIGS. 2-4, 6, and 7, in an orientation relative to the shaft 102 as thetabs were inserted into the opening 104, e.g., with a concave surface orconvex surface thereof facing the retention element 110. In anotherembodiment, a chamber can be configured to otherwise non-loosely holdbroken reduction tabs in another way, such as by stacking broken tabsone against another similar to a deck of cards. A chamber can beconfigured to loosely hold broken reduction tabs therein by allowingbroken reduction tabs to be freely disposed therein in no particularorder and/or in no particular orientation relative to the shaft, asdiscussed further below.

A chamber formed in a shaft of a surgical instrument can be formed inany portion of the shaft. In some embodiments, a chamber can extendthrough the shaft from a position proximal to an opening formed in adistal end of the shaft to a proximal end of the shaft. As in theillustrated embodiment, the chamber 112 can extend from a position tothe opening 104 formed in the distal end 102 d of the shaft 102 to aposition distal to the proximal end 102 p of the shaft 102, which canprovide space within the shaft 102 for the release mechanism 114,discussed further below.

The retention element 110 can have a variety of sizes, shapes, andconfigurations. The retention element 110 can include a bar, as in theillustrated embodiment, although the retention element 110 can haveother forms, such as a coiled spring. The retention element 110 can beat least partially disposed within the shaft 102, as in the illustratedembodiment in which a proximal portion of the retention element 110 isdisposed within the shaft 102 and a distal portion of the retentionelement 110 is at least partially disposed outside the shaft 102.

The retention element 110 can be positioned at least partially withinthe shaft 102 so as to allow the retention element 110 to directlycontact a reduction tab inserted into the opening 104, e.g., the firstreduction tab 106 a as shown in FIGS. 2, 4, and 6. The retention element110 can thus be configured to directly contact at least a distal-mostreduction tab disposed within the shaft 102. The retention element 110can be configured to directly contact a reduction tab inserted into theopening 104 in a variety of ways. In an exemplary embodiment, theretention element 110 can include a distal portion thereof configured todirect a force toward one side of the shaft 102, e.g., toward one sideof an interior sidewall of the shaft 102, such that the force can hold areduction tab within the shaft 102 when the reduction tab is engaged bythe force. The retention element 110 can be configured to direct theforce in a variety of ways, such as by being spring loaded, as in theillustrated embodiment, such that the retention element 110 is biasedtoward the one side of the shaft 102. The retention element 110 can bespring loaded by, e.g., having a proximal end thereof attached to theshaft 102, e.g., using one or more pins 120, as shown in FIGS. 2 and5-7, with a distal end of the retention element 110 being freely movablerelative to the shaft 102. The force can be strong enough to hold thefirst reduction tab 106 a in the shaft 102 but be weak enough that,after the first reduction tab 106 a has been broken and is retainedwithin the shaft by the retention element 110, a subsequent reductiontab, e.g., the second reduction tab 106 b, inserted into the opening 104can displace the first reduction tab 106 a, e.g., push the firstreduction tab 106 a toward the chamber 112.

The retention element 110 can have a pinch point 122 in a distal portionthereof, as shown in FIGS. 2-4, 6, and 7. The pinch point 122 can bedisposed adjacent to and proximal to the opening 104 and can beconfigured to directly contact the first retention tab 106 a received inthe opening 104 to hold the first retention tab 106 a received in theopening 104 in a fixed position, both before and after the firstreduction tab 106 a has been broken from its associated implant, e.g.,broken from the head 108. The force applied by the retention element 110can thus be applied at the pinch point 122. The pinch point 122 can bedisposed between the opening 104 and a distal-most end of the chamber112. The retention tab 110 can thus be configured to hold the firstreduction tab 106 a before the retention tab 110 is fully disposedwithin the chamber 112, either loosely or non-loosely. A distance of thepinch point 122 from the opening 104 can be a distance less than alength of the first reduction tab 106 a, which can allow the retentionelement 110 to directly contact the first reduction tab 106 a at thepinch point 122 when the first reduction tab 106 a in inserted into theopening 104. Reduction tabs of surgical implants have known lengths, soa pinch point of a retention element can be appropriately located in aninstrument to directly contact reduction tabs.

As mentioned above, the instrument 100 can be configured to receivereduction tabs oriented in different ways relative to the opening 104 inwhich the tabs are sequentially received. The pinch point 122 of theretention element 110 can thus be configured to engage a concave side ofa reduction tab to securely hold the reduction tab within the shaft 102,such as with the fourth and fifth reduction tabs 106 d, 106 e, and toengage a convex side of a reduction tab to securely hold the reductiontab within the shaft 102, such as with the first and third reductiontabs 106 a, 106 c.

The distal end of the retention element distal to the pinch point 122can bend or curve away from the side of the shaft 102 to which theretention element 110 directs the force, as shown in FIGS. 2-4, 6, and7. The bend or curve can help facilitate smooth insertion of the firstreduction tab 106 a into the opening 104 and help direct the firstreduction tab 106 a proximally into the shaft 102.

The retention element 110 can be configured to move between a firstconfiguration in which the retention element 110 is in a first positionrelative to the longitudinal axis A of the shaft 102 and a secondconfiguration in which the retention element 110 is in a second positionrelative to the longitudinal axis A of the shaft 102. The secondconfiguration can be radially offset from the first configurationrelative to the longitudinal axis A. The retention element 110 in thefirst configuration can be configured to hold the reduction tab 106 ainserted into the opening 104 in a fixed position, and the retentionelement 110 in the second configuration can be configured to allow thereduction tab 106 a inserted into the opening 104, as well as anyreduction tabs disposed within the chamber 112, e.g., the third, fourth,and fifth tabs 106 c, 106 d, 106 e, to be released from the shaft 102.The second configuration of the retention element 110 can thus beradially away from the side of the shaft 102 to which the retentionelement 110 is configured to direct the force, e.g., away from theinterior sidewall of the shaft 102 against which the reduction tab 106 ainserted into the opening 104 is held by the retention element 110.

The release mechanism 114 can have a variety of sizes, shapes, andconfigurations. The release mechanism 114 can include a selectivelyactuatable plunger, as in the illustrated embodiment, although therelease mechanism 114 can have other forms, as discussed further below,such as a selectively actuatable lever and a movable end cap. Therelease mechanism 114 can be spring loaded, e.g., with the spring 116,as in the illustrated embodiment.

The release mechanism 114 can be at least partially disposed within theshaft 102, as in the illustrated embodiment in which a distal portion ofthe release mechanism 114 is disposed within the shaft 102 and aproximal portion of the release mechanism 114 is at least partiallydisposed outside the shaft 102, thereby allowing the proximal portion ofthe release mechanism 114 to be accessible by hand for manual actuationof the release mechanism 114. The release mechanism 114 can bepositioned at least partially within the shaft 102 so as to allow therelease mechanism 114 to directly contact a portion of the retentionelement 110 disposed with the shaft 102, as shown in FIG. 7. The releasemechanism 114 can be actuated, e.g., by pushing distally on the proximalend of the release mechanism 114, thereby compressing the spring 116 andpushing a cam surface 124 of the release mechanism 114 distally againstthe retention element 110. The cam surface 124 can be at a distal end ofthe release mechanism 114. The cam surface 124 can include an angled camsurface, as in the illustrated embodiment as shown in FIGS. 2 and 5-7,which can facilitate camming of the retention element 110 by the releasemechanism 114, as discussed further below.

Generally, the release mechanism 114 can be configured to be movablebetween a locked configuration and an unlocked configuration. In thelocked configuration, shown in FIGS. 2, 5, and 6, the release mechanism114 can be configured to retain broken tabs within the shaft 102 and toprevent release of retained broken tabs from the shaft 102. In theunlocked configuration, shown in FIG. 7, the release mechanism 114 canbe configured to allow release of retained broken tabs from within theshaft 102. The release mechanism 114 can be configured in the unlockedconfiguration to allow release of retained broken tabs by pushing thecam surface 124 against the retention mechanism 110, thereby moving thepinch point 122 away from the side of the shaft 102 to which it isforced or biased. Any reduction tab held by the retention element 110 atthe pinch point 122, e.g., the first reduction tab 106 a, and anyreduction tabs contained within the chamber 112, e.g., the third,fourth, and fifth tabs 106 c, 106 d, 106 e, can be released from theshaft 102 through the opening 104, e.g., through gravity. The releasemechanism 114 can thus be configured to allow the instrument 100 to beeasily unloaded during a surgical procedure to free space within thechamber 112 for more broken tabs by allowing release of broken reductiontabs from within the shaft 102. The release mechanism 114 can also allowthe instrument 100 to continue being used during a surgical procedure tobreak and retain reduction tabs even after the instrument 100 has brokenand retained a maximum number of broken tabs that can be containedtherein.

The release mechanism 114 can be biased to the locked configuration,thereby helping to prevent an accidental release of broken tabs from theinstrument 100. In other words, a default position of the releasemechanism 114 can be in the locked configuration. The release mechanism114 can be biased to the locked configuration in a variety of ways. Asin the illustrated embodiment, the release mechanism 114 can bespring-biased to the locked configuration with the spring 116. Thespring 116 can be configured to provide a biasing force to the releasemechanism 114 effective to hold the release mechanism 114 in the lockedconfiguration, e.g., with the cam surface 124 not exerting a forceagainst the retention element 110 so as to allow the pinch point 122 ofthe retention element 110 to directly contact the first reduction tab106 a inserted into the opening 104. Actuating the release mechanism 114can move the release mechanism 114 between the locked configuration andthe unlocked configuration.

As shown in FIG. 1, the shaft 102 can include a slot 118 formed thereinthat is configured to facilitate release of broken tabs from within theshaft 102. The slot 118 can be in communication with the chamber 112.The slot 118 can be configured to have a tool (not shown), e.g., a rod,a scalpel tip, etc., inserted therein and into the chamber 112. The slot118 can be configured to allow a tool inserted therein to slide withinthe slot 118 to engage and push at least one broken tab within thechamber 112. The tool can be slid distally within the slot 118 to urgebroken tab(s) within the chamber 112 out of the instrument 100 throughthe opening 104. The slot 118 can thus help broken tab(s) be quicklyremoved from within the shaft 102, help unjam any broken tab(s) withinthe shaft 102 in the unlikely event that the tab(s) become jammedtherein, and/or help clear foreign material (e.g., tissue, blood, etc.)other than broken tab(s) from within the shaft 102. The tool can be slidwithin the slot 118 whether or not any broken tabs are within thechamber 112, which can facilitate clearing the chamber 112 of foreignmaterial to, e.g., clear space for broken tabs to be disposed within thechamber 112.

Although the slot 118 can have a variety of configurations and positionsin the shaft 102, in the illustrated embodiment, the slot 118 is alongitudinal slot extending parallel to a longitudinal axis A of theshaft 102 and extending between a distal point proximal to the distalend 102 d of the shaft 102 and a proximal point distal to the proximalend 102 p of the shaft 102. The proximal point can be adjacent to aproximal end of the chamber 112, which can facilitate pushing brokentabs within the chamber 112 distally using a tool inserted into the slot118. The slot 118 can be formed on an opposite side to which the pinchpoint 122 is biased, as in the illustrated embodiment.

The first reduction tab 106 a received in the opening 104 at the distalend 102 d of the shaft 102 can be broken off its associated surgicalimplant in a variety of ways. In an exemplary embodiment, the shaft 102can be configured to break the first reduction tab 106 a by rotatingabout the longitudinal axis A of the shaft 102, e.g., by manual rotationof the shaft 102, and/or by angularly orienting the shaft 102 relativeto the first reduction tab 106 a, e.g., by manually tilting the shaft102. The rotational force and/or torsional force applied by the shaft102 to the first reduction tab 106 a can cause the first reduction tab106 a to snap off its associated implant. The retention element 110 canengage and hold the first reduction tab 106 a within the shaft 102 priorto breakage of the first reduction tab 106 a, as discussed above, andthe retention element 110 can accordingly retain and hold the firstreduction tab 106 a within the shaft 102 post-breakage. The firstreduction tab 106 a after being broken from its associated implant canthus be securely held within the shaft 102, e.g., cannot be releasedtherefrom without actuating the release mechanism 114.

FIG. 6 illustrates the first reduction tab 106 a disposed in the shaft102 and held therein by the retention element 110 after being broken offthe tab's associated surgical implant, e.g., snapped off the head 108 ofthe implant. From the locked configuration of FIG. 6, the releasemechanism 114 can be actuated, e.g., the plunger can be pushed distally,as shown in FIG. 7, to move the release mechanism 114 to the unlockedconfiguration to allow the broken first reduction tab 106 a and thebroken reduction tabs 106 c, 106 d, 106 e disposed in the chamber 112 tobe released from the shaft 102.

Below are discussions of various other embodiments of surgicalinstruments configured to break and retain multiple reduction tabs ofone or more surgical implants. The various embodiments discussed belowcan generally be configured and used similar to the surgical instrument100 of FIGS. 1-7. Additionally, like-named elements and like-illustratedelements of the surgical instrument 100 and of the surgical instrumentsdiscussed below can be configured and used similar to one another.

FIGS. 8-10 illustrate another embodiment of a surgical instrument 200configured to break and retain multiple reduction tabs of one or moresurgical implants. The surgical instrument 200 includes a shaft 202having an opening 204 at a distal end thereof, a retention element 210,a chamber 212 formed in the shaft 202, a release mechanism 214, and alongitudinal slot 218 formed in the shaft 202. An exterior surface ofthe shaft 202 can include one or more grip features configured tofacilitate hand gripping of the shaft 202. The one or more grip featurescan help prevent the shaft 202 from slipping out of a surgeon's handduring insertion of tab(s) into the opening 204 and/or during breakageof reduction tab(s) using the shaft 202. Non-limiting examples of theone or more grip features can include a textured surface, fingerhold(s), raised protrusion(s), and depression(s). In the illustratedembodiment, the one or more grip features include a plurality ofdepressions 203 formed in the shaft 202. The one or more grip featurescan be formed in at least a proximal portion of the shaft 202, e.g., ina portion of the shaft 202 most likely to be manipulated by hand duringuse.

As shown in FIGS. 9 and 10, the instrument 200 can include a jam releasemechanism 215. The jam release mechanism 215 can have a variety ofsizes, shapes, and configurations. The jam release mechanism 215 caninclude a bar, as in the illustrated embodiment, although the jamrelease mechanism 215 can have other forms, such as a coiled spring.

The jam release mechanism 215 can be configured to facilitate release ofbroken reduction tabs retained in the chamber 212. The jam releasemechanism 215 can thus be configured to cooperate with the releasemechanism 214 to release broken reduction tabs from the shaft 102. Thejam release mechanism 215 can be attached to the release mechanism 214such that the jam release mechanism 215 is configured to move in tandemwith the release mechanism 214, e.g., when the release mechanism 214moves between locked and unlocked configurations. The jam releasemechanism 215 can be attached to the release mechanism 214 in a varietyof ways, such as by using one or more pins 217. The jam releasemechanism 215 can be configured to have a distal end 215 d thereofpositioned in the chamber 212 distal to a cam surface 224 of the releasemechanism 214 such that the release mechanism 214 moving distally causesthe distal end 215 d of the jam release mechanism 215 to move distallyin the chamber 212. The distal end 215 d of the jam release mechanism215 can thus be configured to distally push broken reduction tab(s)disposed in the chamber 212, facilitating release thereof through theopening 204. The jam release mechanism 215 can be positioned toward aside of the shaft 202 to which the retention element 210 is biased suchthat when the cam surface 224 of the release mechanism 214 urges theretention element 210 away from the side of the shaft 202, the jamrelease mechanism 215 does not get in the way of the retention element'smovement, and vice versa.

As shown in FIGS. 8-10, the instrument 200 can include a stop element219 configured to stop the retention element 210 from moving beyond acertain point when the release mechanism 214 is urging the retentionelement 210 away from the side of the shaft 202 to which the retentionelement 210 is biased. In this way, the retention element 210 can havemovement thereof restrained to within a certain distance radially awayfrom the shaft 202, which can help prevent the retention element 210from interfering with other instruments and/or other material in asurgical space. The stop element 219 can have a variety of sizes,shapes, and configurations. As in the illustrated embodiment, the stopelement 219 can include a bar spanning across the slot 218 in a distalportion of the slot 218.

FIGS. 11-14 illustrate another embodiment of a surgical instrument 300configured to break and retain multiple reduction tabs of one or moresurgical implants. The surgical instrument 300 includes a shaft 302having an opening 304 at a distal end thereof, one or more grip features303 on the shaft 302, a retention element 310, a chamber 312 formed inthe shaft 302, a release mechanism 314, a jam release mechanism 315, astop element 319, and a longitudinal slot 318 formed in the shaft 302.The jam release mechanism 315 in the illustrated embodiment is notattached to the release mechanism 314 so as to move in tandem therewith.Instead, the jam release mechanism 315 is configured to be movableindependent of the release mechanism 314. In other words, the jamrelease mechanism 315 can be selectively actuated separate from therelease mechanism 314 to facilitate removal of broken reduction tab(s)from within the shaft 302. The jam release mechanism 315 can beconfigured to be selectively actuated in a variety of ways. As in theillustrated embodiment, the jam release mechanism 315 can include anactuator 315 a configured to be manipulated to move the jam releasemechanism 315 relative to the shaft 302. The actuator 315 a can beconfigured to be manually actuated, such as by sliding the actuator 315a longitudinally back and forth, e.g., proximally and distally, therebyallowing the jam release mechanism 315 to move back and forth within thechamber 312 to help unjam any jammed broken reduction tabs containedtherein. The jam release mechanism 315 can include a post 315 p coupledto the actuator 315 a and configured to move within a second slot 321,shown in FIG. 14, formed in the shaft 302 to help guide the jam releasemechanism 315 back and forth relative to the shaft 302.

FIGS. 15-19 illustrate another embodiment of a surgical instrument 400configured to break and retain multiple reduction tabs of one or moresurgical implants. The surgical instrument 400 includes a shaft 402having an opening 404 at a distal end thereof, a retention element 410,and a chamber 412 formed in the shaft 402. The chamber 412 can beconfigured to loosely retain broken reduction tabs therein. The chamber412 can extend along a majority of a longitudinal length of the shaft402, which can help maximize a number of broken reduction tabs that canbe simultaneously retained therein. To enter the chamber 412 so as to beloosely held therein, a broken reduction tab held by a pinch point 422of the retention element 410 can be pushed proximally toward the chamber412 by a reduction tab inserted into the opening 404 immediatelysubsequent to the broken reduction tab. Depending on the lengths of thebroken reduction tab and the immediately subsequent reduction tab, thebroken reduction tab may be pushed fully into the chamber 412 or may bepushed toward the chamber 412 in a channel 411, shown in FIGS. 16, 18,and 19, extending between and connecting the opening 404 and the chamber412 without being fully disposed therein until another reduction tab isinserted into the opening 404.

Broken reduction tabs loosely disposed in the chamber 412 can bereleased from the shaft 402 by turning the shaft 402 and allowing thebroken reduction tabs to slide out of an open proximal end 402 p of theshaft 402. The shaft 402 can optionally include an end cap (not shown)at the proximal end 402 p thereof that can serve as a release mechanismconfigured to retain the broken reduction tabs within the shaft 402until actuation of the end cap, e.g., removal or opening thereof. Theend cap can be attached to the shaft 402 and movable relative thereto ina variety of ways, e.g., mateable threads, a hinged connection similarto a flip-top lid, a magnetic connection, etc.

The retention element 410 can be spring loaded by, e.g., having aproximal end thereof attached to the shaft 402, e.g., using a spring421, as shown in FIG. 16 (the spring 421 is not shown for clarity inFIGS. 18 and 19), and having an intermediate point thereof attached tothe shaft 402 at a pivot point thereof, e.g., using a pin 420, as shownin FIGS. 15, 16, 18, and 19, such that the retention element 410 canpivot about the pin 420 as the spring 421 compresses and decompresses.FIGS. 15-18 illustrate the retention element 410 in a firstconfiguration in which the retention element 410 can be configured tohold a reduction tab inserted into the opening 404 in a fixed position,and FIG. 19 illustrates the retention element 410 in a secondconfiguration in which the retention element 410 can be configured toallow a reduction tab inserted into the opening 404, as well as anyreduction tabs disposed within the chamber 412 to be released from theshaft 402 through the opening 404 and/or through the open proximal end402 p.

FIGS. 20-23 illustrate another embodiment of a surgical instrument 500configured to break and retain multiple reduction tabs of one or moresurgical implants. The surgical instrument 500 includes a shaft 502having an opening 504 at a distal end thereof, a retention element 510,and a chamber 512 formed in the shaft 502. The retention element 510 canbe spring loaded and can be pivotable using a spring 521 (not shown inFIG. 22 for clarity of illustration) and a pivot pin 520, similar to thespring 421 and the pin 420 of the embodiment illustrated in FIGS. 15-19.The retention element 510 can be configured as a release mechanism ofthe instrument 500 by being configured to be selectively, manuallymovable between a first configuration in which the retention element 510can be configured to hold a reduction tab inserted into the opening 504in a fixed position, and a second configuration in which the retentionelement 510 can be configured to allow a reduction tab inserted into theopening 504, as well as any reduction tabs disposed within the chamber512 to be released from the shaft 502 through the opening 504. Also, theretention element 510 in the second configuration can allow an unbrokenreduction tab held by a pinch point 522 of the retention element 510 tobe released from the instrument 500 through the opening 504. Similar tothat discussed above regarding the instrument 100 of FIGS. 1-7, in thesecond configuration, the retention element 510 can be radially offsetfrom the first configuration relative to a longitudinal axis AS of theshaft 502 such that the pinch point 522 of the retention element 510 canbe radially offset from its position in the first configuration relativeto the longitudinal axis A5. FIGS. 20, 21, and 23 show the retentionelement 510 in the first configuration, and FIG. 22 shows the retentionelement 510 in the second configuration.

The retention element 510 can be configured to be selectively, manuallymovable between the first and second configurations in a variety ofways. In the illustrated embodiment, the retention element 510 includesa manually depressible tab 510 t at a proximal end thereof. The manuallydepressible tab 510 t can be selectively pushed down, e.g., radiallyinward, which can cause the retention element 510 to pivot about thepivot pin 520 and cause the pinch point 522 to move up, e.g., radiallyoutward. Releasing the manually depressible tab 510 t can allow theretention element 510 to pivot about the pivot pin 520 and cause thepinch point 522 to move down.

Similar to the chamber 412 of the embodiment illustrated in FIGS. 15-19,the chamber 512 can be configured to loosely retain broken retentiontabs therein, and the shaft 502 can be configured to release brokenretention tabs retained therein through an open proximal end 502 pthereof and/or through the opening 504. The open proximal end 502 p canoptionally include an end cap (not shown) closing the proximal end 502 psuch that loose tabs in the chamber 512 cannot be released through theproximal end 502 p without first releasing the end cap, e.g., flippingthe end cap open, unthreading the end cap from the shaft 502, etc.

FIGS. 24-29 illustrate another embodiment of a surgical instrument 600configured to break and retain multiple reduction tabs of one or moresurgical implants. The surgical instrument 600 includes a shaft 602having an opening 604 at a distal end thereof, a retention element 610,a chamber 612 formed in the shaft 602, and a release mechanism 614. Theretention element 610 can be spring biased by having a proximal endthereof attached to the shaft 602 by compression fit as in theillustrated embodiment or in another way, e.g., using one or more pins(not shown), with a distal end of the retention element 610 being freelymovable relative to the shaft 602.

The release mechanism 614 can include a lever configured to beselectively, manually actuatable to move the retention element 610between first and second configurations to allow broken reduction tabsto be selectively released from the shaft 602 through the opening 604and/or to allow an unbroken reduction tab held by a pinch point 622 ofthe retention element 610 to be released from the instrument 600 throughthe opening 604. The shaft 602 can include a recessed portion 602 c,shown in FIGS. 26 and 29, formed therein that can be configured to seatthe lever and allow movement of the lever therein, which can helpprevent the lever from interfering with other materials, e.g.,instruments, tissue, etc., in a surgical space. As shown in FIGS. 25,27, and 28, the release mechanism 614 can include a cam 614 c, e.g., ata distal end thereof, configured to engage the retention element 610 tomove the retention element 610 between the first and secondconfigurations. The cam 614 c can be configured to rotate in response tomanual actuation of the lever, thereby allowing the retention element610 to pivot. FIGS. 24-27 and 29 show the retention element 610 in thefirst configuration, and FIG. 28 shows the retention element 610 in thesecond configuration.

Similar to the chamber 412 of the embodiment illustrated in FIGS. 15-19,the chamber 612 can be configured to loosely retain broken retentiontabs therein, and the shaft 602 can be configured to release brokenretention tabs retained therein through an open proximal end 602 pthereof and/or through the opening 604. The open proximal end 602 p canoptionally include an end cap (not shown) closing the proximal end 602 psuch that loose tabs in the chamber 612 cannot be released through theproximal end 602 p without first releasing the end cap. The end cap andthe lever can both be release mechanisms for the instrument 600.

FIGS. 30-34 illustrate another embodiment of a surgical instrument 700configured to break and retain multiple reduction tabs of one or moresurgical implants. The surgical instrument 700 includes a shaft 702having an opening 704 at a distal end thereof, a retention element 710,a chamber 712 formed in the shaft 702, and a release mechanism 714.Similar to the retention element 610 in the embodiment of FIGS. 24-29,the retention element 710 can be spring biased by having a proximal endthereof attached to the shaft 702 by compression fit as in theillustrated embodiment or in another way, with a distal end of theretention element 710 being freely movable relative to the shaft 702.The release mechanism 714 can, similar to the release mechanism 614 inthe embodiment of FIGS. 24-29, include a cam 714 c and a leverconfigured to be selectively, manually actuatable to move the retentionelement 710 between first and second configurations to allow brokenreduction tabs to be selectively released from the shaft 702 through theopening 704 and/or to allow an unbroken reduction tab held by a pinchpoint 724 of the retention element 714 to be released from theinstrument 700 through the opening 704. FIGS. 30-33 show the retentionelement 710 in the first configuration, and FIG. 34 shows the retentionelement 710 in the second configuration.

Similar to the chamber 412 of the embodiment illustrated in FIGS. 15-19,the chamber 712 can be configured to loosely retain broken retentiontabs therein, and the shaft 702 can be configured to release brokenretention tabs retained therein through an open proximal end 702 pthereof and/or through the opening 704. The open proximal end 702 p canoptionally include an end cap (not shown) closing the proximal end 702 psuch that loose tabs in the chamber 712 cannot be released through theproximal end 702 p without first releasing the end cap. The end cap andthe lever can both be release mechanisms for the instrument 700.

FIG. 35 illustrates another embodiment of a surgical instrument 800configured to configured to break and retain multiple reduction tabs ofone or more surgical implants. The surgical instrument 800 includes ashaft 802 having an opening 804 at a distal end thereof, a retentionelement 810, a chamber 812 formed in the shaft 802, and a releasemechanism 814. The retention element 810 can be spring loaded by, e.g.,having a proximal end thereof attached to the shaft 802, e.g., using aspring 821, and having an intermediate point thereof attached to theshaft 802 at a pivot point thereof, e.g., using a pin 820, similar tothe retention element 410 of the embodiment illustrated in FIGS. 15-19.The release mechanism 814 can include a slidable bar configured to beselectively, manually actuatable to move the retention element 810between first and second configurations to allow broken reduction tabsto be selectively released from the shaft 802 through the opening 804and/or to allow an unbroken reduction tab held by a pinch point 822 ofthe retention element 810 to be released from the instrument 800 throughthe opening 804. The slidable bar can be configured to be longitudinallymovable, e.g., parallel to a longitudinal axis A8 of the shaft 802, topivot the retention element 810 to about the pin 820, thereby moving thepunch point 822 up (e.g., radially outward) and down (e.g., radiallyinward). A distal end 814 d of the release mechanism 814 can beconfigured to slide along a surface 810 s of the retention element 810as the release mechanism 814 is selectively moved back and forth toselectively pivot the retention element 810. A proximal portion of therelease mechanism 814 can extend proximally beyond a proximal end 802 pof the shaft 802, thereby facilitating manual sliding movement of therelease mechanism 814.

Similar to the chamber 412 of the embodiment illustrated in FIGS. 15-19,the chamber 812 can be configured to loosely retain broken retentiontabs therein, and the shaft 802 can be configured to release brokenretention tabs retained therein through an open proximal end 802 pthereof and/or through the opening 804. The open proximal end 802 p canoptionally include an end cap (not shown) closing the proximal end 802 psuch that loose tabs in the chamber 812 cannot be released through theproximal end 802 p without first releasing the end cap. The end cap andthe slidable bar can both be release mechanisms for the instrument 800.

FIGS. 36 and 37 illustrate another embodiment of a surgical instrument900 configured to break and retain multiple reduction tabs of one ormore surgical implants. The surgical instrument 900 includes a shaft 902having an opening 904 at a distal end thereof, a retention element 910,a chamber (not shown) formed in the shaft 902, and a release mechanism914. The retention element 910 can be spring loaded by, e.g., having aproximal end thereof attached to the shaft 902, e.g., using a spring,and having an intermediate point thereof attached to the shaft 902 at apivot point thereof, e.g., using a pin 920, similar to the retentionelement 410 of the embodiment illustrated in FIGS. 15-19.

Similar to the release mechanism 814 of the embodiment illustrated inFIG. 35, the release mechanism 914 can include a slidable bar configuredto be selectively, manually actuatable to move the retention element 910between first and second configurations to allow broken reduction tabsto be selectively released from the shaft 902 through the opening 904and/or to allow an unbroken reduction tab held by a pinch point 922 ofthe retention element 910 to be released from the instrument 900 throughthe opening 904. The slidable bar can be configured to be longitudinallymovable, e.g., parallel to a longitudinal axis A9 of the shaft 902, topivot the retention element 910 up and down. A distal end 914 d of therelease mechanism 914 can be configured to slide along a surface 910 sof the retention element 910 as the release mechanism 914 is selectivelymoved back and forth to selectively pivot the retention element 910. Aproximal portion of the release mechanism 914 can include one or moregrip features 914 g configured to facilitate hand gripping of therelease mechanism 914. The one or more grip features 914 g in thisillustrated embodiment includes a ridged, raised protrusion, but asmentioned above, grip features of an instrument can be configured in avariety of ways.

Similar to the chamber 412 of the embodiment illustrated in FIGS. 15-19,the chamber can be configured to loosely retain broken retention tabstherein, and the shaft 902 can be configured to release broken retentiontabs retained therein through a proximal end 902 p thereof and/orthrough the opening 904. The proximal end 902 p can optionally includean end cap 901 closing the proximal end 902 p such that loose tabs inthe chamber cannot be released through the proximal end 902 p withoutfirst releasing the end cap 901. The end cap 901 in the illustratedembodiment is threadably connected to the proximal end 902 p of theshaft 902, but as mentioned above, the end cap 901 can be attached tothe shaft 902 in any of a variety of ways. The end cap 901 and theslidable bar can both be release mechanisms for the instrument 900. Theend cap 901 can have a cut-out 901 c therein configured to allowslidable movement of the slidable bar therein.

FIGS. 38-40 illustrate another embodiment of a surgical instrument 1000configured to break and retain multiple reduction tabs of one or moresurgical implants. The surgical instrument 1000 includes a shaft 1002having an opening 1004 at a distal end thereof, a retention element1010, and a chamber (not shown) formed in the shaft 1002. Similar to theretention element 510 of the embodiment illustrated in FIGS. 20-23, theretention element 1010 can be configured as a release mechanism of theinstrument 1000 by being configured to be selectively, manually movablebetween a first configuration in which the retention element 1010 can beconfigured to hold a reduction tab inserted into the opening 1004 in afixed position, and a second configuration in which the retentionelement 1010 can be configured to allow a reduction tab inserted intothe opening 1004, as well as any reduction tabs disposed within thechamber to be released from the shaft 1002 through the opening 1004.

The retention element 1010 can be configured to be selectively, manuallymovable in a variety of ways, such as by manually moving the retentionelement 1010 away from a side S of the shaft 1002 to which the retentionelement 1010 is biased, e.g., in an angled proximal direction indicatedby arrow R in FIG. 39, to move the retention element 1010 from the firstconfiguration to the second configuration. The retention element 1010can be moved in a direction opposite to the arrow R to move theretention element 1010 from the second configuration to the firstconfiguration. The retention element 1010 can be biased to the firstconfiguration such that removing manual force from the retention element1010 when the retention element 1010 is in the second configuration cancause the retention element 1010 to automatically move to from thesecond configuration to the first configuration. The direction of thearrow R is a non-limiting direction. The retention element 1010 caninclude one or more grip features 1010 g configured to facilitate handgripping of the retention element 1010. The one or more grip features1010 g in this illustrated embodiment includes a raised protrusion, butas mentioned above, grip features of an instrument can be configured ina variety of ways.

Similar to the slot 118 in the embodiment illustrated in FIGS. 1-7, theshaft 1002 can include a slot 1018, shown in FIG. 40, formed thereinthat is configured to facilitate release of broken tabs from within theshaft 1002. The slot 1018 can be a longitudinal slot extending parallelto a longitudinal axis A10 of the shaft 1002 and can be on a same side Sof the shaft 1002 to which the retention element 1010 can be biased, andcan be opposite a pinch point (not shown) of the retention element 1010,which can help facilitate removal of one or more reduction tabs in adistal portion of the device.

Similar to the chamber 412 of the embodiment illustrated in FIGS. 15-19,the chamber can be configured to loosely retain broken retention tabstherein, and the shaft 1002 can be configured to release brokenretention tabs retained therein through a proximal end 1002 p thereofand/or through the opening 1004. Similar to the embodiment illustratedin FIGS. 36 and 37 that includes the end cap 901, the proximal end 1002p of the shaft 1002 can include an end cap 1001.

FIGS. 41 and 42 illustrate another embodiment of a surgical instrument1100 configured to break and retain multiple reduction tabs of one ormore surgical implants. The surgical instrument 1100 includes a shaft1102 having an opening 1104 at a distal end thereof, a retention element1110, a chamber (not shown) formed in the shaft 1102, and an end cap1101. Similar to the retention element 1010 of the embodimentillustrated in FIGS. 38-40, the retention element 1110 can be configuredas a release mechanism of the instrument 1100 by being configured to beselectively, manually movable between a first configuration in which theretention element 1110 can be configured to hold a reduction tabinserted into the opening 1104 in a fixed position, and a secondconfiguration in which the retention element 1110 can be configured toallow a reduction tab inserted into the opening 1104, as well as anyreduction tabs disposed within the chamber to be released from the shaft1102 through the opening 1104. The retention element 1110 can beconfigured to be selectively, manually movable in a variety of ways,such as by manually moving the retention element 1110 away from a sideS11 of the shaft 1102 to which the retention element 1110 is biased.Also, the retention element 1110 can include one or more grip features1110 g, e.g., a raised protrusion, configured to facilitate handgripping of the retention element 1110. The end cap 1101 and theretention element 1110 can both be release mechanisms for the instrument1100.

FIGS. 43-45 illustrate another embodiment of a surgical instrument 1200configured to break and retain multiple reduction tabs of one or moresurgical implants. The surgical instrument 1200 includes a shaft 1202having an opening 1204 at a distal end thereof, a retention element1210, a chamber 1212 formed in the shaft 1202, and an end cap 1201. Theshaft 1202 can have one or more windows 1202 w formed therein. In theillustrated embodiment, the shaft 1202 includes a plurality of windowsformed therein in a proximal portion thereof adjacent the chamber 1212.The windows 1202 w can be configured to allow visualization of thechamber 1212, which can facilitate determining whether the chamber 1212is becoming so full of broken reduction tabs such that broken reductiontabs should be released therefrom, e.g., through the opening 1204 and/orthrough the shaft's proximal end 1202 p (with the end cap 1202 actuatedout of the way). The one or more windows 1202 w can have a variety ofsizes, shapes, and configurations. The one or more windows 1202 w areeach circular cut-outs in the shaft 1202 each having a same size in theillustrated embodiment, but any one of more of the windows 1202 w canhave a shape different from any one or more of the other windows 1202 w,and a size different from any one or more of the other windows 1202 w.Although the one or more windows 1202 w are cut-outs in the illustratedembodiment, the one or more windows 1202 w can be transparent portionsof the shaft 1202 w instead of cut-outs therein, which can help containany fluid and/or other debris that enters the chamber 1212 through theopening 1204 from passing out of the chamber 1212 through any of thewindows 1202 w.

Similar to the retention element 1010 of the embodiment illustrated inFIGS. 38-40, the retention element 1210 can be configured as a releasemechanism of the instrument 1200 by being configured to be selectively,manually movable between a first configuration in which the retentionelement 1210 can be configured to hold a reduction tab inserted into theopening 1204 in a fixed position, and a second configuration in whichthe retention element 1210 can be configured to allow a reduction tabinserted into the opening 1204, as well as any reduction tabs disposedwithin the chamber to be released from the shaft 1202 through theopening 1204. The retention element 1210 can be configured to beselectively, manually movable in a variety of ways, such as by manuallymoving the retention element 1210 away from a side S12 of the shaft 1202to which the retention element 1210 is biased. Also, the retentionelement 1210 can include one or more grip features 1210 g, e.g., araised protrusion, configured to facilitate hand gripping of theretention element 1210. The end cap 1201 and the retention element 1210can both be release mechanisms for the instrument 1200.

FIG. 46 illustrates another embodiment of a surgical instrument 1300configured to break and retain multiple reduction tabs of one or moresurgical implants. The surgical instrument 1300 includes a shaft (notshown) having an opening (not shown) at a distal end thereof, aretention element 1310, a chamber (not shown) formed in the shaft, and arelease mechanism 1314. The retention element 1310 can be spring loadedby, e.g., having a proximal end thereof attached to the shaft using aspring element 1321, e.g., a coil spring, a volute spring, a bellows, anelastic band, etc., such that the retention element 1310 can pivot abouta pivot pin 1320. The release mechanism 1314 can, similar to the releasemechanism 814 in the embodiment shown in FIG. 35, include a slidable barconfigured to be selectively, manually actuatable to move the retentionelement 1310 between first and second configurations to allow brokenreduction tabs to be selectively released from the shaft through theopening and/or to allow an unbroken reduction tab held by a pinch point1322 of the retention element 1310 to be released from the instrument1300 through the opening. The slidable bar can include first, second,and third bars 1314 b 1, 1314 b 2, 1314 b 3 pivotally connected to oneanother at first and second pivot points 1314 a, 1314 b such that movingthe third bar 1314 b 3, e.g., by manually moving the third bar 1314 b 3up and down, can slide the release mechanism 1314, e.g., a distal end ofthe first bar 1314 a, along the retention element 1310.

FIG. 47 illustrates another embodiment of a surgical instrument 1400configured to break and retain multiple reduction tabs of one or moresurgical implants. The surgical instrument 1400 includes a shaft (notshown) having an opening (not shown) at a distal end thereof, aretention element 1410, a chamber (not shown) formed in the shaft, and arelease mechanism 1414. The retention element 1410 can be spring loadedby, e.g., having a proximal end thereof attached to the shaft using aspring element 1421, e.g., a coil spring, a volute spring, a bellows, anelastic band, etc., such that the retention element 1410 can pivot abouta pivot pin 1420. The release mechanism 1414 can, similar to the releasemechanism 814 in the embodiment shown in FIG. 35, include a slidable barconfigured to be selectively, manually actuatable to move the retentionelement 1410 between first and second configurations to allow brokenreduction tabs to be selectively released from the shaft through theopening and/or to allow an unbroken reduction tab held by a pinch point1422 of the retention element 1410 to be released from the instrument1400 through the opening. The release mechanism 1414 can be slidablycoupled to the release mechanism 1414 such that the release mechanism1414, e.g., a distal end thereof, can be slidably received in a slot1410 s formed in the retention element 1410.

FIGS. 48-54 illustrate another embodiment of a surgical instrument 1500configured to break and retain multiple reduction tabs of one or moresurgical implants. The surgical instrument 1500 includes a shaft 1502having an opening 1504 at a distal end thereof, a retention element1510, a chamber 1512 formed in the shaft 1502, and an end cap 1501.

FIG. 54 shows a distal portion of the instrument 1500 that includes theopening 1504 and the retention element 1510 as having a threadedproximal portion configured to threadably engage a threaded distalportion of the shaft 1502. This distal portion can be attached to theshaft 1502 in another way, e.g., welding, snap fit, etc. In an exemplaryembodiment, this distal portion of the instrument 1500 is not removablefrom the shaft 1502 once attached thereto but is threaded with the shaft1502 so as to facilitate manufacturing of the instrument 1500.Alternatively, this distal portion of the instrument 1500 can beconfigured to be removable from the shaft 1502 by unthreading the distalportion of the instrument 1500 from the shaft 1502, which can facilitatecleaning and/or sterilization of the instrument 1500.

Similar to that discussed above regarding the embodiment illustrated inFIGS. 15-19, the retention element 1510 can be spring loaded, e.g.,having a proximal end thereof attached to the shaft 1502, e.g., by beingwelded thereto as a cantilevered spring. FIGS. 48-53 show the instrument1500 with the retention element 1510 in a first configuration in whichthe retention element 1510 can be configured to hold a reduction tabinserted into the opening 1504 in a fixed position and held therein by apinch point 1522 of the retention element 1510. The retention element1510 can be configured to move between the first configuration and asecond configuration (not shown) in which the retention element 1510,e.g., a portion thereof including the pinch point 1522, has movedradially outward relative to the shaft 1502, to holds reduction tab. Thefirst configuration of the retention element 1510 can be the neutral ordefault configuration of the retention element 1510, as in theillustrated embodiment, such that the retention element 1510 is biasedto a position in which the pinch point 1522 is biased radially inwardrelative to the shaft 1502, which can facilitate secure holding of a tabby the pinch point 1522.

The retention element 1510 can be positioned on a side of the opening1504, e.g., along a short side of the opening 1504, configured to beadjacent to a side edge of a reduction tab inserted into the opening1504. In this way, the retention element 1510 can be configured tointerchangeably hold reduction tabs having a concave side or a convexside facing to a same side of the opening 1504, e.g., to a long side ofthe opening 1504. In other words, the retention element 1510 can beconfigured to hold a reduction tab having a curved shape regardless ofthe tab's orientation relative to the opening 1504 when inserted intothe opening 1504.

The instrument 1500 includes only one retention element 1510, but theinstrument 1500 can include a plurality of retention elements eachconfigured to simultaneously hold a same tab within the opening 1504.Having a plurality of retention elements can help securely hold a tab ina fixed position within the opening 1504, can facilitate the holding ofdifferently sized reduction tabs that are inserted into the opening1504, and/or can allow each of the retention elements to deflect lesswhen engaging a tab so as to help the instrument 1500 take up less spacewithin a surgical area. For example, the instrument 1500 can include asecond retention element (not shown) on an opposite side of the opening1504 from the retention element 1510.

Similar to that discussed above regarding the embodiment illustrated inFIGS. 15-19, the end cap 1501 can be a release mechanism for theinstrument 1500. Also similar to the embodiment illustrated in FIGS.15-19, the chamber 1512 can be configured to loosely retain brokenretention tabs therein, and the shaft 1502 can be configured to releasebroken retention tabs retained therein through a proximal end 1502 pthereof. Similar to the embodiment illustrated in FIGS. 36 and 37 thatincludes the end cap 901, the proximal end 1502 p of the shaft 1502 caninclude the end cap 1501. The end cap 1501 is removably and replaceablycoupled to the shaft 1502 via a threaded connection in the illustratedembodiment, but as mentioned above, the end cap 1501 can be removablyand replaceably attached to the shaft 1502 in other ways, e.g., amagnetic attachment, a snap fit, etc.

The end cap 1501 can include a protrusion 1501 p configured to beinserted into the opening 1504 when the end cap 1501 is not attached tothe shaft's proximal end 1502 p. The protrusion 1501 p can be configuredto engage and push proximally at least one broken tab within theinstrument 1500 when the protrusion 1501 p is inserted into the opening1504. The protrusion 1501 p can thus help broken tab(s) be quicklyremoved from within the shaft 1502 even if the tab is being held by thepinch point 1522, help unjam any broken tab(s) within the shaft 1502 inthe unlikely event that the tab(s) become jammed therein, and/or helpclear foreign material (e.g., tissue, blood, etc.) other than brokentab(s) from within the shaft 1502. The protrusion 1501 p can be insertedinto the opening 1504 whether or not any broken tabs are within thechamber 1512 and/or are being held by the retention element 1510, whichcan facilitate clearing foreign material to, e.g., clear space forbroken tabs to be disposed within the instrument 1500. Since theretention element 1510 can be biased to the first configuration, asmentioned above, inserting the protrusion 1501 p into the opening 1504can allow a tab being held by the pinch point 1522 to be pushedproximally into the chamber 1512 so as to allow the tab to be removedfrom the instrument 1500, e.g., by exiting through the shaft's proximalend 1502 p when the cap 1501 is not attached thereto.

The protrusion 1501 p can have a variety of sizes, shapes, andconfigurations. The protrusion 1501 p can have a size and shapecorresponding to a size and shape of the opening 1504 so as to helpmaximize an amount of space the protrusion 1501 p can clear within theinstrument 1500 when inserted into the opening 1504. In the illustratedembodiment, the protrusion 1501 p has a rectangular box shape and arectangular cross-sectional shape, which corresponds to a rectangularshape and a rectangular cross-sectional shape of the opening 1504.

As shown in FIG. 53, the protrusion 1501 p can have a longitudinallength L1 that is equal to or greater than a distance D1 between adistal end of the opening 1504 and the pinch point 1522 of the retentionelement 1510. The protrusion 1501 p being at least as long as thisdistance D1 can help ensure that the protrusion 1501 p is able to pushproximally a broken tab (not shown) being held at the pinch point 1522by the retention element 1510. In an exemplary embodiment, theprotrusion's longitudinal length L1 can be equal to or greater than alongitudinal length L2 of the opening 1504, which can help ensure thatthe protrusion 1501 p is able to move proximally through an entirelength of the opening 1504 and thereby help clear any foreign materialfrom the opening 1504.

The protrusion 1501 p can extend distally from the end cap 1501, asshown in FIGS. 58, 60, and 61. The protrusion 1501 p can be configuredto be at least partially disposed within the chamber 1512 when the endcap 1501 is attached to the shaft 1502, as shown in FIGS. 51 and 53, inwhich the protrusion 1501 p is shown partially disposed in a proximalportion of the chamber 1512. The protrusion 1501 p can thus beunobtrusively coupled to the instrument 1500 so as to not interfere witha user's handling of the instrument 1500.

FIGS. 55-61 illustrate another embodiment of a surgical instrument 1600configured to break and retain multiple reduction tabs of one or moresurgical implants. The surgical instrument 1600 includes a shaft 1602having an opening 1604 at a distal end thereof, a retention element1610, a chamber 1612 formed in the shaft 1602, and an end cap 1601having a protrusion 1601 p extending therefrom.

The end cap 1601 can be configured similar to the end cap 1501 of theembodiment illustrated in FIGS. 48-54. The protrusion 1601 p can beconfigured similar to the protrusion 1501 p of the embodimentillustrated in FIGS. 48-54, e.g., be configured to be insertable intothe opening 1604, be configured to be at least partially disposed in thechamber 1612 when the cap 1601 is attached to the shaft 1602, etc.

FIG. 61 shows a distal portion of the instrument 1600 that includes theopening 1604 that extends through a proximal tip component 1605, adistal tip component 1607, and the retention element 1610 as having athreaded proximal portion, e.g., on the proximal tip component 1605,configured to threadably engage a threaded distal portion of the shaft1602. The distal portion of the instrument 1600 can be attached to theshaft 1602 in another way, e.g., welding, snap fit, etc. Similar to thatdiscussed above with respect to the distal portion of the instrument1500 of the embodiment illustrated in FIGS. 48-54, this distal portionof the instrument 1600 is not removable from the shaft 1602 onceattached thereto, but this distal portion of the instrument 1600 can beremovable from the shaft 1602.

As also shown in FIG. 61, the retention element 1610 can include aplurality of retention elements, e.g., first and second opposedretention elements 1610 a, 1610 b. Similar to that discussed aboveregarding the embodiment illustrated in FIGS. 15-19, the retentionelements 1610 a, 1610 b can be spring loaded. The first and secondopposed retention elements 1610 a, 1610 b can be configured to bedisposed on opposed sides of the opening 1604, e.g., along opposed shortsides of the opening 1604, configured to be adjacent to opposed sideedges of a reduction tab inserted into the opening 1604. In this way,the retention element 1610 can be configured to interchangeably holdreduction tabs having a concave side or a convex side facing to a sameside of the opening 1604, e.g., to a long side of the opening 1604. Inother words, the retention element 1610 can be configured to hold areduction tab having a curved shape regardless of the tab's orientationrelative to the opening 1504 when inserted into the opening 1504.

The first and second opposed retention elements 1610 a, 1610 b can beintegrally formed, as in the illustrated embodiment, so as to be asingle retention element component. Being a single retention elementcomponent can facilitate manufacture of the instrument 1600 by allowingfor better control of manufacturing tolerances for each of theinstrument's retention elements 1610 a, 1610 b, which can facilitatecontrol of a distance between the retention elements 1610 a, 1610 b whencoupled to the shaft 1604. Alternatively, the first and second opposedretention elements 1610 a, 1610 b can be separate components, e.g., eachbe configured similar to the retention element 1500 of the embodimentillustrated in FIGS. 48-54.

Each of the first and second retention elements 1610 a, 1610 b can beconfigured to move between first and second configurations, similar tothat discussed above with respect to the retention element 1510 of theembodiment illustrated in FIGS. 48-54.

At least a portion of the opening 1604 can have an “I” cross-sectionalshape, as shown in FIGS. 55, 56, and 61. “The “I” cross-sectional shapecan allow the opening 1604 to interchangeably receive reduction tabstherein having a concave side facing either long side of the opening1604, similar to that discussed above with respect to the rectangularcross-shaped opening 104 of FIGS. 1-7. A reduced diameter portion in amiddle of the “I” shape can facilitate predictable positioning of tabssequentially inserted into the opening 1604. The “I” cross-sectionalshape can help a reduction tab inserted into the opening 1604 be alignedwith an immediately previous one of the tabs inserted into the opening1604, even if the concave sides of the tabs face different directions,so as to effectively proximally push the immediately previous one of thetabs toward the chamber 1612. In other words, a mid-portion of each oneof the tabs inserted into the opening 1604 can be positioned in thereduced diameter portion in a middle of the “I” shape such that at leastthe mid-portions of sequentially inserted tabs can be more likely to bealigned so as to allow the mid-portions to abut and facilitate pushingof a previously inserted tab.

In an exemplary embodiment, at least a distal portion of the opening1604 can have the “I” cross-sectional shape. In this way, a reductiontab can be inserted into the opening 1604 in the predictable positionfacilitated by the “I” cross-sectional shape. In the illustratedembodiment, a distal portion of the opening 1604, e.g., a portion of theopening 1604 in the distal tip component 1605, has an “I”cross-sectional shape. A remainder of the opening 1604 can have anothercross-sectional shape. In the illustrated embodiment, as shown in FIG.61, a proximal portion of the opening 1604 that extends through theretention element 1610 and the proximal tip component 1607 has arectangular cross-sectional shape.

The devices disclosed herein can be designed to be disposed of after asingle use, or they can be designed to be used multiple times. In eithercase, however, the device can be reconditioned for reuse after at leastone use. Reconditioning can include any combination of the steps ofdisassembly of the device, followed by cleaning or replacement ofparticular pieces, and subsequent reassembly. In particular, the devicecan be disassembled, and any number of the particular pieces or parts ofthe device, e.g., the blades, can be selectively replaced or removed inany combination. Upon cleaning and/or replacement of particular parts,the device can be reassembled for subsequent use either at areconditioning facility, or by a surgical team immediately prior to asurgical procedure. Those skilled in the art will appreciate thatreconditioning of a device can utilize a variety of techniques fordisassembly, cleaning/replacement, and reassembly. Use of suchtechniques, and the resulting reconditioned device, are all within thescope of the present application.

Preferably, the invention described herein will be processed beforesurgery. First, a new or used instrument is obtained and if necessarycleaned. The instrument can then be sterilized. In one sterilizationtechnique, the instrument is placed in a closed and sealed container,such as a plastic or TYVEK bag. The container and instrument are thenplaced in a field of radiation that can penetrate the container, such asgamma radiation, x-rays, or high-energy electrons. The radiation killsbacteria on the instrument and in the container. The sterilizedinstrument can then be stored in the sterile container. The sealedcontainer keeps the instrument sterile until it is opened in the medicalfacility.

It is preferred that device is sterilized. This can be done by anynumber of ways known to those skilled in the art including beta or gammaradiation, ethylene oxide, steam, and a liquid bath (e.g., cold soak).

One skilled in the art will appreciate further features and advantagesof the invention based on the above-described embodiments. Accordingly,the invention is not to be limited by what has been particularly shownand described, except as indicated by the appended claims. Allpublications and references cited herein are expressly incorporatedherein by reference in their entirety.

1-20. (canceled)
 21. A surgical instrument, comprising: an elongateshaft having proximal and distal ends and a chamber formed therein; anopening at the distal end of the shaft sized to receive a reduction tabof a surgical implant therein and being in communication with thechamber of the shaft; and a first retention arm positioned on a firstside of the opening, the first retention arm having a proximal endattached to the shaft and being configured to move between a firstposition in which a pinch point of the first retention arm is positionedin the opening to engage a reduction tab received in the opening and asecond position in which the pinch point is moved radially-outwardrelative to the first position.
 22. The instrument of claim 21, furthercomprising a second retention arm positioned on a second side of theopening opposite to the first side of the opening, the second retentionarm having a proximal end attached to the shaft and being configured tomove between a first position in which a pinch point of the secondretention arm is positioned in the opening to engage a reduction tabreceived in the opening and a second position in which the pinch pointis moved radially-outward relative to the first position.
 23. Theinstrument of claim 22, wherein the opening includes opposed third andfourth sides and wherein the first and second sides of the opening arelonger than the third and fourth sides.
 24. The instrument of claim 22,wherein the opening includes opposed third and fourth sides and whereinthe first and second sides of the opening are shorter than the third andfourth sides.
 25. The instrument of claim 21, wherein the firstretention arm is welded to the shaft.
 26. The instrument of claim 21,wherein the first retention arm comprises a cantilevered spring andwherein the pinch point of the first retention arm comprises aprotrusion that extends radially-inward from the first retention arm.27. The instrument of claim 21, wherein the opening has a rectangularcross-section in a plane transverse to a longitudinal axis of the shaft.28. The instrument of claim 27, wherein the chamber has a circularcross-section in a plane transverse to the longitudinal axis of theshaft.
 29. The instrument of claim 21, wherein the first retention armis biased toward the first position.
 30. The instrument of claim 21,wherein the pinch point of the first retention arm is configured to moveradially outward as a reduction tab is inserted into the opening. 31.The instrument of claim 21, further comprising a threaded connection ata proximal end of the shaft configured to attach the shaft to an endcap.
 32. The instrument of claim 21, further comprising at least onebone anchor having a head configured to seat a spinal rod, the headhaving first and second breakable reduction tabs extending proximallytherefrom, each of the first and second reduction tabs being configuredto fit within the opening of the instrument.
 33. A surgical instrument,comprising: an elongate shaft having proximal and distal ends and achamber formed therein, the elongate shaft tapering to a reduced distalportion; a rectangular opening formed in the reduced distal portion ofthe elongate shaft, the opening being sized to receive a reduction tabof a surgical implant therein and being in communication with thechamber of the shaft; a first retention arm positioned on a first sideof the opening, the first retention arm having a proximal end attachedto the reduced distal portion of the shaft and being configured to movebetween a first position in which a pinch point of the first retentionarm is positioned in the opening to engage a reduction tab received inthe opening and a second position in which the pinch point is movedradially-outward relative to the first position; and a second retentionarm positioned on a second side of the opening opposite to the firstside of the opening, the second retention arm having a proximal endattached to the reduced distal portion of the shaft and being configuredto move between a first position in which a pinch point of the secondretention arm is positioned in the opening to engage a reduction tabreceived in the opening and a second position in which the pinch pointis moved radially-outward relative to the first position.
 34. A surgicalmethod, comprising: disposing a first reduction tab of a bone anchorimplanted within a patient within an opening at a distal end of anelongate shaft such that first and second retention arms attached to theshaft directly contact opposite sides of the first reduction tab;manipulating the shaft to break the first reduction tab disposed withinthe opening; retaining the broken first reduction tab within a chamberformed in the shaft; disposing a second reduction tab of the bone anchorwithin the opening such that the first and second retention armsdirectly contact the second reduction tab; manipulating the shaft tobreak the second reduction tab disposed within the opening; andretaining the broken second reduction tab within the chamber.
 35. Themethod of claim 34, further comprising flexing the first and secondretention arms radially-outward as the first reduction tab is insertedinto the opening.
 36. The method of claim 34, further comprisingsqueezing the first reduction tab between the first and second retentionarms under a bias force of the first and second retention arms.
 37. Themethod of claim 34, further comprising removing the first and secondbroken reduction tabs from the chamber through a proximal end of theshaft.
 38. The method of claim 34, further comprising removing an endcap from a proximal end of the shaft and inserting a projectionextending distally from the end cap into the opening.
 39. The method ofclaim 38, wherein inserting the projection moves a broken reduction tabin a proximal direction out of the opening and into the chamber.